阿托伐他汀对冠状动脉介入术后C反应蛋白的影响

目的:测定经皮腔内冠状动脉介入术(PCI)后C-反应蛋白(CRP)的水平并评价阿托伐他汀对其影响。方法:连续选择因冠状动脉狭窄性病变行PCI的冠心病患者60例,随机分为治疗组和对照组,治疗组在对照组治疗的基础上给予阿托伐他汀20mg,qd,术前及术后2d和3周分别测外周动脉血清CRP。结果:术前、术后2d及术后3周,治疗组CRP水平分别为(9.03±0.59)、(23.5±0.71)及(12.8±0.47)mg/L,对照组则分别为(8.8±0.62)、(21.2±0.56)及(19.6±0.53)mg/L,两组术后3周比较,差异有统计学意义(P<0.01);术前、术后2d及术后3周治疗组CK-MB分别为(11.9±3.3)、(14.6±3.2)、(16.0±2.8)IU/L,对照组为(12.1±3.4)、(14.3±2.6)、(15.6±3.0)IU/L,两组术后CK-MB均无升高,两组术前、术后相比较,均P>0.05。结论:PCI后血清CRP水平升高,阿托伐他汀可明显控制血浆炎症因子,有利于动脉粥样硬化斑块的稳定。     

糖尿病肾病患者血清肝细胞生长因子水平变化分析

目的 探讨肝细胞生长因子(HGF)在糖尿病肾病发生发展中的作用.方法 测定正常人、糖尿病组(单纯糖尿病组、微量白蛋白尿组、蛋白尿肾功能正常组、终末期肾功能衰竭组)共150例研究对象的血清HGF水平,并分析其与尿微量白蛋白等指标的关系.结果 糖尿病组血清HGF水平明显比正常对照组高(P＜0.05).糖尿病组中,微量白蛋白尿组和蛋白尿肾功能正常组两个亚组血清HGF水平明显比单纯糖尿病组高(P＜0.05),终末期肾功能衰竭组血清HGF水平明显比单纯糖尿病组高(P＜0.05),但低于微量白蛋白尿和蛋白尿肾功能正常组(P＜0.05).在出现终末期肾功能衰竭前HGF与尿微量白蛋白正相关(F=6.29、P＜0.05).结论 糖尿病患者随着肾损害的出现其HGF水平亦逐渐增高,但进入终末期肾功能衰竭后HGF水平明显降低.HGF与糖尿病肾病发生发展有关.     

冠状动脉介入术后妊娠相关蛋白A及C反应蛋白的变化及意义

目的探讨冠状动脉介入术(PCI)前后血浆妊娠相关蛋白-A(PAPP-A)及C反应蛋白(CRP)水平[以高敏CRP(hs-CRP)衡量]的变化,以及其对术后6个月内心血管事件和再狭窄发生的预测价值。方法观察56例PCI患者(不稳定型心绞痛35例,稳定型心绞痛17例,心肌梗死4例)手术前及术后24h的PAPP-A、肌钙蛋白Ⅰ、肌酸激酶同工酶及CRP浓度,随访术后6个月内主要心血管事件(心肌梗死、再次血运重建及死亡)的发生情况,并于术后6个月复查冠状动脉造影,采用定量分析冠状动脉的狭窄,并计算后期内径丢失指数。分析手术前后PAPP-A和CRP水平与再狭窄及心血管事件的发生的关系。结果56例患者经PCI均成功,成功率100%;PCI后PAPP-A较术前高(P<0·05);且PCI前后的PAPP-A水平与CRP水平有较好的相关性(P<0·01),而与肌钙蛋白Ⅰ、肌酸激酶同工酶无相关性(P>0·05)。术后6个月内有心血管事件组患者PAPP-A及CRP水平较无心血管事件组高(P<0·01及P<0·05);PCI后6个月内有再狭窄的患者PAPP-A及CRP水平较无再狭窄的患者高((P<0·05及P<0·01),且PAPP-A及CRP与PCI后冠状动脉后期内径丢失指数呈正相关(r=0.70,P<0·01及r=0.71,P<0·01)。结论PCI后可导致体内PAPP-A与CRP合成增加,并在术后6个月内心血管事件及再狭窄的发生有重要作用。     

Long-term, cause-specific mortality after myocardial infarction in diabetes.

AIMS: To compare long-term, cause-specific mortality after reperfusion therapy for ST segment elevation myocardial infarction (STEMI) in patients with and without diabetes. METHODS AND RESULTS: Patients with STEMI (n = 395) were randomised to intravenous streptokinase (SK) or primary percutaneous coronary intervention (PCI). Median follow-up was 7.5 years (interquartile range 5.6-8.5). A total of 74 patients (19%) had diabetes. Reduced left ventricular ejection fraction (<40%) after STEMI was more often observed in patients with diabetes (27% vs. 15%, P = 0.02). Patients with diabetes had a higher total mortality compared to patients without diabetes (HR 2.4; P < 0.001). Multivariate analysis confirmed that diabetes was an independent risk factor for long-term mortality (HR 2.3; P < 0.001). The incidence of sudden death was comparable in both patient groups (HR 1.6; P = 0.23). The increased mortality in patients with diabetes was mainly caused by heart failure (HR 3.1; P = 0.004). In patients with diabetes, primary PCI was associated with an improved prognosis. CONCLUSIONS: Despite reperfusion therapy, STEMI patients with diabetes have an increased long-term mortality. This is due to death by heart failure and not by an increase in sudden death. Primary PCI is associated with an improved prognosis, particularly in patients with diabetes.     

Effects of coronary stenting on vessel patency and long-term clinical outcome after percutaneous coronary revascularization in diabetic patients

OBJECTIVES: We sought to compare coronary stent implantation with balloon angioplasty (BA), in a diabetic population, in terms of the six-month angiographic outcome and four-year clinical events. BACKGROUND: Diabetic patients have a poor angiographic and clinical outcome after standard coronary BA. To date, it is still unclear whether stent implantation may improve this outcome. METHODS: We investigated this issue by individual matching of 314 diabetic patients treated with either coronary stenting or standard BA. These two groups were derived from a population of consecutive diabetic patients (1993 to 1996). Matching criteria were gender, anti-diabetic regimen, stenosis location, reference diameter, and minimal luminal diameter (+/-0.4 mm). One lesion per patient was considered for matching. RESULTS: Baseline characteristics were similar between the two groups of 157 patients. At six months, the rates of restenosis (27% vs. 62%; p < 0.0001) and occlusion (4% vs. 13%; p < 0.005) were lower in the stent group than in the BA group. This was associated with a significant decrease in ejection fraction at six months in the BA group (p = 0.02) while, during the same period, no change was observed in the stent group (p = NS). Subgroup analysis demonstrated that angiographic benefit was consistent among the subgroups. At four years, the combined clinical end point of cardiac death and non-fatal myocardial infarction was lower in the stent group (14.8% vs. 26.0%; p = 0.02), as was the need for repeat revascularization (35.4% vs. 52.1%; p = 0.001). CONCLUSIONS: In a population of diabetic patients, coronary stent implantation was associated with a highly beneficial effect on the six-month angiographic outcome and four-year clinical events compared with standard BA.     

Predictors of revascularization method and long-term outcome of percutaneous coronary intervention or repeat coronary bypass surgery in patients with multivessel coronary disease and previous coronary bypass surgery.

AIMS: The optimal revascularization strategy in patients with symptomatic multivessel coronary artery disease (CAD) and previous coronary artery bypass grafting (CABG) remains unknown. METHODS AND RESULTS: We evaluated all patients with previous CABG undergoing isolated, non-emergency multivessel revascularization between 1 January 1995 and 31 December 2000. The analysis concentrated on the independent predictors of the revascularization method, as well as on long-term mortality and its predictors, after calculating a propensity score for the method of revascularization. There were 2191 patients (1487 with reoperation and 704 with percutaneous coronary intervention, PCI) in the study. The most important factors in choosing reoperation were presence of more diseased or occluded grafts, previous infarction, lower ejection fraction (EF), longer interval from first CABG, and more total occlusions of native arteries, as well as absence of a patent mammary graft. The distribution of the propensity score was skewed towards the two extremes. At 5 years, the unadjusted cumulative survival was 79.5% for CABG and 75.3% for PCI, P=0.008. After adjustment for the propensity score for PCI vs. CABG, PCI was associated with a hazard ratio of 1.47 (0.94-2.28), P=0.09. The most powerful predictors of mortality were higher age and lower EF. CONCLUSION: The choice of the revascularization method in patients with previous CABG is dictated mostly by anatomical considerations and less by clinical characteristics. In contrast, clinical characteristics predominantly affect long-term outcome, whereas the method of revascularization has a limited effect. A randomized clinical trial addressing this important segment of the population with ischaemic heart disease is warranted.     

糖尿病对选择性经皮冠状动脉介入治疗操作及住院期临床事件的影响

目的　比较冠心病合并与不合并糖尿病的患者选择性经皮冠状动脉介入治疗 (PCI)操作及住院期临床事件发生率,分析糖尿病对选择性PCI操作及住院期临床事件的影响。方法　对2002年 1月至 12月在本院连续进行的全部 1294例选择性PCI并置入支架的患者进行回顾性分析,搜集患者临床资料、介入治疗操作技术特点、住院期间各项预后事件。计算PCI操作成功率、支架置入成功率以及临床成功率,用逐步logistic回归模型分析糖尿病对急性期临床事件的影响。结果　糖尿病患者占总体的 20 .8%,糖尿病患者C型病变、双支、三支病变发生率明显高于非糖尿病者 (P<0 .05)。糖尿病组术前狭窄程度、预扩张球囊平均长度、最大直径、最大充盈压力以及最长充盈时间均显著大于非糖尿病组[分别为 (91 .00±6 .62)%对 (89 .81±6 .64)%, (17. 07±6. 31)mm对 (16 .07±7 .28)mm, (2 .30±1 .11)mm对(2 .12±0 .94)mm, (9 .86±4 .40)atm对(9 05±4 75)atm, (20 .94±14 .69)s对(18. 26±14 .65)s,P<0 .05],而所置入支架平均直径较小 [ ( 3 .15±0 .47 )mm对 ( 3 .23±0. 43)mm,P<0. 05]。糖尿病组与非糖尿病组之间的PCI操作成功率、临床成功率差异无统计学意义(分别为 89 6%对 90 .3%, 99 .3%对 99 .2%,P>0. 05),糖尿病不是发生急性期终     

血清C反应蛋白对冠状动脉支架置入术后心血管事件和再狭窄的预测价值

目的　探讨基础血清C反应蛋白 (CRP)水平对冠状动脉支架置入术后 6个月内心血管事件和再狭窄的预测价值。方法　术前测定 78例单支病变的冠状动脉支架置入术患者 [2 8例稳定性心绞痛 (SAP)和 5 0例急性冠脉综合征 (ACS) ]基础血清CRP水平。将患者分为CRP <3 0mg/L(31例 )和CRP≥ 3 0mg/L (4 7例 )两组 ,分析并记录患者术后 1周以及术后 6个月内心血管事件 (心绞痛、心肌梗死及死亡 )发生率及支架内再狭窄 (血管内直径狭窄率≥ 5 0 % )等情况。结果　基础血清CRP水平在ACS组比稳定心绞痛组高 [(7 8± 2 6 )比 (2 8± 0 4 )mg/L ,P <0 0 1];术后 1周内的心血管事件发生率在ACS组、CRP升高组比稳定心绞痛、CRP不高组明显升高 (8%比 3 6 % ,P <0 0 5 ) ;术后6个月的心血管事件及支架内再狭窄发生率亦是CRP高者远高于CRP低者 (2 1 5 %比 7 7% ,P <0 0 1;19 5 %比 7 7% ,P <0 0 1)。结论　基础血清CRP水平是单支冠状动脉病变支架置入术后 6个月内预后的预测指标 ,这提示术后 6个月内心血管事件发生率和支架内再狭窄是和支架置入术前炎症细胞活化程度密切相关。     

冠状动脉介入治疗后心肌钙蛋白T的动态变化及原因分析

目的：了解成功行经皮冠状动脉介入治疗（PCI）病人的心肌肌钙蛋白T（cTnT）水平的动态改变及临床意义。方法：选择成功行PCI术的68例患者，在术前、术后6h、24h分别检测肌酸激酶（CK）、肌酸激酶同功酶（CK-MB）及cTnT水平，并分析相关因素。结果：PCI术后CK—MB升高7例（10．3％）。cTnT术后升高32例（47．1％），C型病变：在cTnT升高组中17例（53．1％），与cTnT正常组10例（27．8％）比较有显著差异（P=0．0330）。三支血管病变：cTnT升高组中13例（40．6％），与cTnT正常组5例（13．9％）比较有显著差异（P=0．0126）。cTnT升高的原因和扩张压力总和、扩张次数及扩张时间有关（P=0．0072，P=0．0002，P=0．0213），支架长度和支架直径也和cTnT水平有关（P=0．0156，P=0．0012）。结论：PCI术后可引起CK-MB、cTnT水平轻度升高，在检测心肌损伤方面cTnT较CK、CK—MB更敏感。病变的复杂程度及手术操作的强度与cTnT水平升高有关。     

辛伐他汀对介入术后急性冠状动脉综合征患者血清炎症因子的影响

目的观察辛伐他汀对介入治疗术后急性冠状动脉综合征患者炎症因子影响及讨论其临床意义。方法住院已行介入治疗单支病变的急性冠状动脉综合征97例,分为辛伐他汀40mg组、辛伐他汀20mg组和对照组,正常组为20名健康成人;测定治疗前、治疗4周后可溶性细胞黏附分子-1、血浆基质金属蛋白酶-9及C反应蛋白水平。结果用药4周后,辛伐他汀40mg组及辛伐他汀20mg组的可溶性细胞黏附分子-1、血浆基质金属蛋白酶-9及C反应蛋白水平均较对照组低（P〈0．01）．而辛伐他汀40mg组较辛伐他汀20mg组更低（P〈0．05）。结论辛伐他汀可减轻介入治疗急性冠状动脉综合征患者的炎症反应;高剂量辛伐他汀抗炎效果更强。     

老年糖尿病合并急性心肌梗死的特点及经皮冠状动脉介入治疗的临床评价

对26例老年急性心肌梗死（AMI）伴2型糖尿病者和52例不伴有2型糖尿病者的研究显示，并发糖尿病者无胸痛、多支和远端冠状动脉血管病变的概率明显高于不伴糖尿病者。经皮介入治疗老年AMI伴糖尿病者仍然安全有效。     

血清肝细胞生长因子测定对急性冠脉综合征患者的临床意义

目的探讨急性冠脉综合征(ACS)患者血清肝细胞生长因子(HGF)水平变化的临床意义。方法入选59例ACS患者(急性心肌梗死组n=36,发病12h以内;不稳定型心绞痛组n=23)于入院时肝素注射前取静脉血,通过酶联免疫法测定血清HGF浓度。同时对与之性别及年龄相匹配的27例正常人测定相同指标。结果血清HGF浓度在AMI组[(1572.9±229.0)pg/ml]、UAP组[(899.2±63.9)pg/ml]较正常对照组[(619.5±31.1)pg/ml]明显增高;AMI发病3h内血清HGF水平也比正常对照组增高[(893.2±61.6)pg/mlvs(619.5±31.1)pg/ml];A-MI组血清HGF浓度与入院时cTnI、CK-MB及CK-MB峰值均无相关性;ACS患者血清HGF浓度与入院时CRP呈显著相关性。结论ACS患者血清HGF浓度增高,且与疾病的严重性呈正比;HGF的产生可能与ACS的炎症反应有关;血清HGF有可能成为临床上诊断早期AMI的一个新指标。     

不同糖耐量水平者血清C反应蛋白水平及阿卡波糖干预的影响

目的　比较不同糖耐量水平者血清C反应蛋白 (CRP)水平 ;观察糖耐量低减 (IGT )患者应用阿卡波糖降糖治疗后血CRP水平的变化。方法　 15 4例受试者 ,行口服 75 g葡萄糖耐量试验 (OGTT)确诊糖耐量正常 (NGT) 44例 ,IGT 89例 ,新诊断的 2型糖尿病 ( 2型DM ) 2 1例 ,其中 60例IGT患者进行为期 16周的随机、双盲、安慰剂对照、阿卡波糖 ( 15 0mg/d)干预治疗试验。血清CRP采用免疫散射比浊法测定。结果　 ( 1)NGT、IGT、新诊断的 2型DM者中 ,血清CRP水平逐渐升高〔中位数 (四分位距 )〕 ,分别为 4.60 ( 4 .10～ 5 .2 5 )、5 .2 5 ( 4 .5 0～ 6.0 0 )和 5 .70 ( 5 .2 0～ 7.5 0 )mg/L(F =15 7.0 0 ,P <0 .0 0 1)。血清CRP水平与OGTT 2h血糖 (r =0 .3 6,P <0 .0 0 1)、HbA1C(r =0 .2 7,P <0 .0 5 )、总胆固醇 (TC ,r =0 .17,P<0 .0 5 )、甘油三酯 (TG ,r =0 .2 7,P <0 .0 1)呈正相关。 ( 2 )在IGT患者 ,应用阿卡波糖治疗 16周后 ,血清CRP水平从 5 .3 5 ( 4 .40～ 6.60 )mg/L下降到 4.90 ( 4 .40～ 5 .5 0 )mg/L(P <0 .0 5 ) ,对照组从 5 .2 5 ( 4 .60～ 5 .80 )mg/L下降到 5 .0 5 ( 4 .60～ 6.0 0 )mg/L(P >0 .0 5 )。 结论　 ( 1)随着糖耐量受损的加重 ,血清CRP水平逐渐升高 ;( 2 )血清CRP水平与OGTT 2h血糖、H     

冠心病合并糖尿病患者冠状动脉旁路移植术长期预后及危险因素的探讨

目的 探讨糖尿病及其合并症对冠状动脉旁路移植术长期预后的影响。方法 将226例连续行冠状动脉主路移植术的冠心病患者分为糖尿病组（116例）和非糖尿病组（110例），应用多变量分析方法分析两组患者术前及术后的临床特征，并随访术后总死亡率及心脏性死亡的发生率，探讨糖尿病组心脏性死亡的预测因素。结果 两组术前及术后的临床特征、既往心肌梗死病史及冠状动脉病变支数等差异无显著性。结果 两组术前及术后的临床特征、既往心肌梗死病史及冠状动脉病变支数等差异无显著性。平均随访3.5年总死亡率两组差异无显著性，但心脏性死亡的发生率糖尿病组明显高于非糖尿病组（15％与3％，P＜0.01）。糖尿病和术后低左室射血分数与心脏性死亡的发生率密切相关（95％可信区间1.29-15.20)。糖尿病组的心脏性主要是猝死、心力衰竭和心肌梗死。术后低左室射血分数、女性及糖尿病肾病是主要预测因素。结论 冠心病合并糖尿病患者冠状动脉旁路移植术长期预后不良，特别在低左室射血分数、女性及糖尿病肾病患者心脏性死亡的发生率高，预后差。应加强对糖尿病患者冠状动脉旁路移植术后心、肾功能障碍的治疗。     

糖尿病伴发急性心肌梗死患者直接经皮 冠状动脉腔内成形术后近期与远期预后

目的　探讨糖尿病伴发急性心肌梗死（AMI）患者直接经皮冠状动脉腔内成形术（PTCA）后近期与远期预后。方法　339例连续行直接PTCA的AMI患者分成糖尿病组（63例）与非糖尿病组（276例）,分析两组患者一般临床特征及冠状动脉病变特点,并随访主要心血管事件的发生率。结果　两组间冠状动脉病变差异无显著性;糖尿病组与非糖尿病组比较,近期随访中(1个月内)左室射血分数（LVEF）减低（0.54±0.10）%vs(0.60±0.13)%,P＜0.05,非致命性心力衰竭发生率增高（16.7%vs7.1%,P＜0.05）,但心脏性病死率差异无显著性（P>0.05）;远期随访平均(20.6±8.7)个月,糖尿病组非致命性心力衰竭与靶血管血运重建率增高（P分别为＜0.05,P＜0.01）,主要心血管事件发生率增加（63.0%vs32.7%,P＜0.01）,且无主要心血管事件存活率降低(37.0%vs67.3%,P<0.01),但两组间总心脏性病死率,差异无显著性(7.4%vs3.9%,P>0.05);多变量分析显示,糖尿病因素及LVEF值与主要心血管事件发生率密切相关,是影响无主要心血管事件存活率的独立危险因素,但糖尿病是无主要心血管事件存活率降低的最重要的预测因素（RR4.15,95%可信区间l.29～15.62）。结论　AMI伴糖尿病患者直接PTCA治疗后无主要心血管事件存活率仍低于不伴糖尿病患者,但两组间总心脏性病死率差异无显著性;与以往静脉溶栓治疗比较,直接PTCA对AMI伴有糖尿病高危患者在降低心脏性病死率方面仍有一定优势。     

基线C反应蛋白水平对老年冠心病血管重建患者预后的影响

目的探讨基线C反应蛋白(CRP)水平对老年冠心病血管重建患者预后的影响。方法选择冠心病血管重建患者209例,根据CRP水平分为低CRP组(CRP≤5 mg/L)113例,高CRP组(CRP>5 mg/L)96例。比较不同基线CRP水平患者长期随访的临床结果,中位随访时间为551 d。结果与低CRP组比较,高CRP组患者随访主要不良心脑血管事件(MACCE)的相对危险度为3.208(95%CI:1.415～7.274,P=0.003)。高CRP组发生再次血管重建的危险为低CRP组的3.841倍(95%CI:1.299～11.357,P=0.008)。Cox回归分析显示,CRP对随访MACCE有显著的独立预测意义,高CRP组无MACCE发生率明显低于低CRP组。结论基线CRP水平仍是老年冠心病血管重建患者预后的独立预测因素。     

C-reactive protein plasma levels but not factor VII activity predict clinical outcome in patients undergoing elective coronary intervention

BACKGROUND: Both vascular inflammation as determined by C-reactive protein (CRP) and extrinsic coagulation as measured by factor VII activity (F VII) may predict clinical restenosis rate in patients with stable angina pectoris undergoing elective percutaneous coronary intervention (PCI). HYPOTHESIS: The primary objective of this study was to investigate the associations between baseline CRP levels, F VII activity, and restenosis rate after elective PCI in a 6-month follow-up period. METHODS: This prospective study included 81 patients aged > or = 19 years undergoing PCI for angiographically significant (> or = 70%) stenosis, with or without stenting, and 49 controls. Factor VII activity and CRP were measured in samples collected at angiography and 16-24 h post procedure after overnight fast. Successful PCI was defined as final diameter of < 50% with TIMI 3 flow and no complication within 1 h. After 6 months all patients who had undergone PCI were evaluated via a standardized questionnaire. Clinical restenosis was defined as the occurrence of a major adverse coronary events (MACE), within the follow-up period. RESULTS: Diagnostic angiography led to a significant increase in CRP levels after 16-20 h in patients with discrete CAD (n = 22) but not in patients without any signs of coronary atherosclerosis (n = 27). During a 6-month follow-up after PCI, 17 of 81 (21%) patients developed MACE. Tertiles of CRP levels independently predicted clinical restenosis, as it developed in 33.3% of patients with the highest CRP levels (0.7-4.8 mg/dl), in 16.6% of patients with second tertile CRP levels (0.23-0.69 mg/dl), and in 7.4% of patients with lowest tertile CRP levels (0.0-0.22 mg/dl). There was a significant difference in the restenosis rate between patients from the first and the third tertiles (p = 0.018). Successful PCI was associated with a significant decrease of mean CRP levels after 6 months, whereas PCI in patients suffering from MACE led to no change in CRP levels. There was no association between factor VII activity and clinical outcome after PCI, and F VII activity did not change over a 6-month period. CONCLUSIONS: In patients with stable angina pectoris undergoing elective PCI, increased preprocedural and 6-month follow-up CRP plasma levels are associated with clinical restenosis. Factor VII plasma activity lacks such correlations.     

Pre-procedural plasma levels of C-reactive protein and interleukin-6 do not predict late coronary angiographic restenosis after elective stenting.

AIMS: Inflammatory markers may serve as an important prognostic predictor in patients with coronary heart diseases. In patients undergoing coronary interventions, it has been shown that baseline C-reactive protein (CRP) could predict late clinical restenosis. Only a few small studies have examined the possible relationship with angiographic restenosis. In patients with stable angina pectoris,we examined whether baseline CRP and IL-6 predict late coronary angiographic restenosis after stenting. METHODS AND RESULTS: Pre-procedural plasma levels of CRP and IL-6 were measured in 216 patients with stable angina pectoris undergoing elective coronary stenting. Angiographic follow-up was performed in all patients at 6 months. Baseline CRP levels were 6.15 +/- 0.78 mg/L versus 5.24 +/- 1.17 mg/L in the patent and restenosis groups, respectively (P=0.64). IL-6 levels were 0.46 +/- 0.03 ng/L versus 0.40 +/- 0.07 ng/L in the patent and restenosis groups, respectively (P=0.50). CRP levels were obtained again at the time of angiographic follow-up and were found to be similar in both groups (2.89 +/- 0.29 mg/L versus 2.61 +/- 0.63 mg/L, P=0.72). Moreover, in a sub-group of 43 patients, serial blood samples were obtained at several time points after the procedure up to 6 months. Both CRP and IL-6 plasma levels increased significantly in response to the procedure. CRP levels peaked at 3 days (11.27 +/- 1.53 mg/L versus 4.26 +/- 0.72 mg/L at baseline, P<0.0001). IL-6 levels reached maximum values after 24 h (1.08 +/- 0.14 ng/L versus 0.53 +/- 0.08 ng/L at baseline, P<0.0001). However, in this sub-group of patients, neither peak CRP nor IL-6 levels were found to predict late angiographic restenosis. CONCLUSIONS: Coronary stenting is associated with transient increases in both CRP and IL-6 levels. However, pre-procedural CRP and IL-6 levels do not predict late coronary angiographic restenosis.     

血浆高敏C反应蛋白对冠状动脉介入术后早期并发症及再狭窄的预测价值

目的　探讨心绞痛患者行经皮冠状动脉介入治疗 (PCI)前 ,高敏C 反应蛋白 (hs CRP)水平对早期并发症及术后再狭窄的预测价值。方法　对 12 0例心绞痛的患者 (5 2例稳定型心绞痛 ,6 8例不稳定型心绞痛 )入院时测定血浆hs CRP水平 ,然后行单支血管的经皮冠状动脉腔内成形术(PTCA) ,随访 1年 ,观察早期并发症及晚期再狭窄发生率 ,对其进行分析。结果　 12 0例患者中 ,血浆hs CRP升高者 6 8人 ,早期并发症均发生在高hs CRP水平者。再狭窄发生率为 4 6 % ,其中血浆hs CRP正常者 14例 ,占 2 7% ;血浆hs CRP升高者 37例 ,占 6 3% (P <0 0 0 1)。经多因素回归分析显示 ,术前CRP水平增高 (r=11 7,P <0 0 0 1)、高血压 (r=4 3,P =0 0 3)、女性 (r=4 1,P =0 0 13)是预测早期并发症的独立危险因素 ,而高CRP(r=6 7,P <0 0 0 1)及术后残余狭窄 (r=3 2 ,P =0 0 0 7)是预测再狭窄的独立危险因素。结论　血浆hs CRP水平可作为炎症标志物反映冠状动脉炎症情况 ,对PTCA早期并发症及术后再狭窄有一定的预测价值。     

Initial management and long-term clinical outcome of restenosis after initially successful percutaneous transluminal coronary angioplasty.

Restenosis remains a critical limitation after percutaneous transluminal coronary angioplasty (PTCA). The clinical experience with restenosis was reviewed in 1,490 patients who had restenosis of at least 1 site within 1 year of their PTCA. The source of data was the clinical database at Emory University. Patients who had previous coronary bypass surgery or PTCA and patients who underwent PTCA in the setting of acute myocardial infarction were excluded. When restenosis was angiographically documented, 363 were treated medically, 1,051 with repeat PTCA, and 76 with coronary bypass surgery. In the repeat PTCA group there were 778 patients who originally had 1-vessel disease and 273 with multiple vessel disease. Re-dilatation of restenotic sites was performed in 95%. Angiographic success of all lesions dilated was achieved in 99%. Coronary bypass surgery was required in 2.5% of patients with restenosis first treated with repeat PTCA. One patient with multiple vessel disease died. Coronary bypass surgery was performed in fewer patients aged greater than or equal to 65 years, but more patients with multiple vessel disease. Two (2.6%) of the coronary bypass surgery patients had Q-wave myocardial infarction and there were no deaths. In the PTCA group, 5-year actuarial survival was 95%, and cardiac survival 96%. Freedom from cardiac events or further revascularization procedures was 51% at 5 years. Patients treated with PTCA and medically treated patients had similar cardiac survival rates. The most important correlates of cardiac survival were age and the presence of diabetes mellitus. At 5 years, cardiac survival without diabetes was 97 and 83% with diabetes (p less than 0.0001).(ABSTRACT TRUNCATED AT 250 WORDS)